S895 Geographic and Risk Factor Disparities in Stomach and Esophageal Cancer Burden Across the US: Findings From GBD 2021

Introduction: Stomach and esophageal cancers remain significant contributors to cancer burden in the U.S., but their epidemiologic contours differ. This study uses Global Burden of Disease (GBD) 2021 data to compare incidence, prevalence, and risk factor-attributable disability-adjusted life years (DALYs) for these malignancies across states and age groups. Methods: We used age-standardized incidence and prevalence rates to assess interstate variation. Gross case numbers were analyzed across age groups to identify high-burden subpopulations. For risk factor (RF) analysis, age-standardized DALY rates attributable to specific RFs were used. Results: Stomach cancer incidence showed considerable geographic variation, with the Pacific and Southern States (Hawaii: 7.88, Louisiana: 6.70, Mississippi: 6.05) having the highest rates, and Mountain/Northern States (Idaho: 3.82, Vermont: 3.96, Utah: 4.03) the lowest. Prevalence patterns closely mirrored incidence. The highest DALYs and prevalence occurred in the 65-74 year age group for both genders, though peak incidence was at 65-74 years in men and 85+ years in women. Esophageal cancer showed a different pattern. Incidence was highest in the District of Columbia (5.73), Maine (5.64), and West Virginia (5.35), and lowest in Utah (3.16), California (3.17), and Hawaii (3.50). Men aged 65-74 years bore the heaviest burden with 6,635 incident cases and 131,288 DALYs. For women, the highest incidence and DALYs were also seen at 65-74 years, while deaths peaked at 75-84 years. RF analysis uncovered distinct etiologies. Stomach cancer was primarily driven by habitual exposures such as smoking (DALY 13.09 in Mississippi) and high-sodium diets (8.24 in Hawaii). Esophageal cancer was linked to smoking (63.29 in West Virginia), alcohol use (30.03 in D.C.), low vegetable intake, and chewing tobacco—particularly in Appalachian and Northeastern states. Conclusion: Stomach cancer shows a coastal-southern pattern with dietary and tobacco RFs; esophageal cancer clusters in Appalachia/Northeast with multifactorial lifestyle drivers. The 65-74 year age group consistently bears the heaviest load. Preventive strategies should include targeted smoking cessation in Appalachia, salt-reduction campaigns in the South, alcohol moderation in high-use states, and national initiatives to boost vegetable intake. State-level interventions must align with regional RF patterns to reduce this dual cancer burden.